At Zika summit, officials stress need for funding and action now to avoid crisis later

ATLANTA — Local and state agencies need to be preparing now for the possibility of mosquito-borne transmission of Zika, federal officials said at a summit Friday.

If the United States waits for active virus transmission or until large numbers of American babies start being born with Zika-related defects, “we have waited too long,” Amy Pope, a White House deputy homeland security advisor, told hundreds of local and state officials gathered at the Centers for Disease Control and Prevention.

But as CDC director Dr. Tom Frieden conceded here at the Zika Action Plan Summit, “It’s hard to get people to invest in [mosquito control] until there’s a crisis.”

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Zika has been spreading in US territories, including Puerto Rico, American Samoa, and the US Virgin Islands, but so far, no local transmission driven by mosquitoes has occurred in the 50 states.

Some experts think it’s just a matter of time, though, before an American resident is infected abroad and then bitten by a mosquito back home, setting the stage for a possible local outbreak on continental US soil.

Frieden singled out Texas, Hawaii, and Florida as the states where US outbreaks are most likely, but noted that such an event could happen elsewhere given the presence of the Aedes mosquitoes that spread the disease in a large number of states.

“We expect it to continue to spread,” Frieden said. “Mosquito season is upon us.”

Frieden said the goal of the summit was to help local and state agencies develop their own plans to take home and implement. One suggestion from the CDC director: states should appoint a Zika coordinator if they haven’t already.

The federal experts, along with mosquito control officials from New York, Texas, and Puerto Rico, outlined ongoing efforts and urged other officials to establish surveillance networks to monitor any spread of the virus.

We must coordinate & collaborate across all levels of government & across sectors & build laboratory capacity #ZikaSummit

They said that sanitation workers, virologists, obstetricians, mothers’ groups, and plenty of others need to be enlisted to monitor for local Zika cases and, if needed, to stamp out local spread.

“This is gonna take a whole community response, with partners that we might not traditionally work with, but they need to be at the table,” said Dr. Nicole Lurie, the assistant secretary for preparedness and response at the Department of Health and Human Services, the parent agency of the CDC.

A challenge for officials in the United States on the lookout for the virus is that cases are hard to track. Tests for Zika are limited and cannot always decipher if someone has been infected with Zika or a related virus, and most people won’t show any symptoms.

According to Lurie, some companies have been anxious to invest in the development of new Zika diagnostic tests because they are not sure if there will be enough funding made available to purchase them. “We’re in a little game of cat and mouse here,” she said.

Lurie and other federal officials used the summit to call again on Congress to approve almost $2 billion in funding for Zika responses, much of which would be funneled down to local and state agencies that do not or cannot prioritize paying for significant mosquito control.

As a New Mexico health official said at the summit, mosquito control in some counties is “one guy in the county who drives a snow plow in the winter” and picks up a fogger in the summer.

Local and state officials said they needed additional funding to combat Zika at a time when they already lack the resources to handle other disease outbreaks or disasters like floods. Plus, the money could help prepare jurisdictions for the next surprise pathogen.

“We know it’s coming,” said Minnesota’s health commissioner Dr. Edward Ehlinger, who also serves as president of the Association of State and Territorial Health Officials.

A primary concern with Zika is that pregnant women who contract the virus appear to face higher risks of having babies with severe defects, including a condition called microcephaly, in which children are born with underdeveloped brains and abnormally small heads.

Officials emphasized their top priority was to protect pregnant women from the virus. In Puerto Rico, for example, where the virus is spreading quickly, that has meant trying to improve access to contraception for women who want it.

As the virus has spread rapidly throughout most of Latin America and the Caribbean, more than 300 American travelers have brought Zika home, and, according to the CDC’s latest tally, there have been six cases of sexual transmission in the continental United States.

All cases of transmission via sex have been from symptomatic men, but Frieden said that does not mean that asymptomatic men cannot spread the virus to a sexual partner.

Twenty-seven of the travel-related infections have been in pregnant women, and Frieden said a number of miscarriages have been reported, although miscarriage is not an uncommon outcome in any pregnancy.

One piece of good news for those living in the United States: Experts believe any local outbreaks will be short-lived and contained. The strong construction of homes, the presence of screens on windows, and the use of air conditioning all reduce Americans’ exposure to mosquitoes.

Viruses like dengue and chikungunya are also spread by the primary Zika driver, the Aedes aegypti mosquito, but there have been few cases of those viruses spread by mosquitoes in the continental United States.

That led Frieden to say that, while some local transmission is possible, “persistent local transmission” is less likely.